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INTRODUCTION

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The importance of the initial trauma assessment cannot be overstated as it sets the tone and conduct for the successive steps in the patient’s overall care. Missed or delayed identification of injuries during the initial assessment can lead to adverse outcomes and complications later in a patient’s hospitalization. Although, there have been multiple studies demonstrating the effectiveness of trauma center care on outcome, in reality, the optimal approach to a trauma patient should be universal regardless of the center. Prompt evaluation and treatment are cornerstones of modern trauma systems, which all starts with the initial assessment.

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The initial assessment begins with an understanding of which patients need an evaluation by a trauma team. After successful field triage (see Chapter 7), the injured patient should be seen in a setting that can accommodate both the patient and the full trauma team. The basic principles of Advanced Trauma Life Support (ATLS) are then utilized with the primary goal of identifying and treating life-threatening injury. Adjunctive tools of evaluation are often employed to help with the assessment. Finally, ongoing evaluation and training of the trauma team should be utilized to maintain readiness.

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TRIAGE

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While the definition of trauma can be easily defined as injury, the patient with an injury requiring the resources and expertise of a trauma team is less clear. The ability to triage or “sort” trauma patients to the appropriate level care can be examined from several different aspects. These include (1) prehospital triage (ie, does this patient require a trauma center?), (2) trauma center designation (ie, in a region where there are several levels of trauma centers which one is most appropriate?), and finally (3) in-hospital triage tiered response (who is going to see and treat the patient upon arrival?). The best outcomes will be generated by a system that is seamlessly connected.

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The most recent Resources for Optimal Care of the Injured Patient recognizes that inclusive regional trauma systems should optimally place the right patient in the right place at the right time.1 Ideally the only difference between hospitals should be related to their resources and not their commitment to provide the best care for the injured patient (see Chapter 4). Trauma patients should be taken directly to the most appropriately equipped center to handle their needs. As such, there are many factors that have been examined to provide field triage to the injured patient which include anatomy, physiology, mechanism, comorbidities, and field triage scores. Of these indices, physiologic parameters provide the most accurate single criteria for triage but ideally a combination of physiologic, anatomic, mechanism, and comorbidities provide better triage than any criteria taken in isolation.2,3 Levels of trauma center designation range from I to IV, with level I centers providing the most comprehensive trauma care and level IVs the least (see Chapter 4). Decisions to transport an injured patient ...

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